Guest Post: What It’s Like In A Mental Hospital

This is a guest post by Ozy Frantz about recent personal experience in a mental hospital for severe depression after a suicide attempt. If you have trouble reading about those topics, the cut it’s behind is for you.

I should know, I was in one. A few months ago, I became deeply depressed and decided to swallow a handful of Tylenol. (Side note: DO NOT try to kill yourself with Tylenol. Well, don’t try to kill yourself with anything, but definitely not with Tylenol. It is a long, slow, painful, awful death that will give you plenty of time to regret every wrong thing you’ve done in your life, starting with deciding to swallow a handful of Tylenol.) A few hours later, I realized that while suicide had many good points viz a viz not feeling pain anymore, it had the slight side effect of being dead.

At the hospital, it turned out I was never in any danger of dying, despite taking a fucking ridiculous number of pills, because my liver deserves some kind of medal for service above and beyond the call of duty. So after a few hours they put me in the mental hospital for seventy-two hours of involuntary confinement.

Throughout this article, I’m mostly going to be talking about my own experience, which is necessarily limited and privileged. My mental hospital was attached to a hospital and used for emergencies and short-term crises, so I don’t know much about longer-term hospitals. I have class privilege, so I could afford to go to a very good mental hospital. The worst thing that happened to me was constant misgendering and being too depressed to educate people about being nonbinary; many people have experiences far worse than mine. I encourage people to share their mental-hospital in the comments, especially if theirs was different than mine.

Hospitalization is never particularly fun. It’s boring, the clothes are terrifically unfashionable, and the food makes school cafeteria food look delicious. If you’re a member of a marginalized group, it sucks worse, because they won’t let your lover visit or you have to worry about how you’re going to afford all this. Most of all, your leg is broken or your appendix has burst, so you’re in pain and miserable because of it. Here’s the secret: mental hospitals are exactly the same.

Before I went in the mental hospital, my idea of the mental hospital was based pretty much on One Flew Over the Cuckoo’s Nest and similar depictions. They’re going to dope me up with medicine without my consent! I’ll end up in a straightjacket in a padded room! I’ll be surrounded by people who think they are Napoleon! Nurse Ratched will torture me! They’ll try to keep you there against your will!

Nope. Of course, sometimes abuse can happen, just like abuse can happen in any kind of hospital, particularly to people who are too weak to fight back. Even though you have the constitutional right to refuse medication, sometimes you’ll be pressured into taking medication you don’t want to take. But all of these are hospital-problems, not mental-hospital problems; if you wouldn’t be scared of going for treatment for cancer because of the risk of abuse, you shouldn’t be scared of going for treatment for depression for the same reason. The only thing I can think of that’s unique is restraints (not straightjackets or padded rooms, both of which are not in use): if the doctors are competent, they’ll only use them if you present a direct threat to yourself or others.

When you check in to the mental hospital, a nurse will take a basic medical history, mostly focusing on medical conditions you currently have that they might have to treat, and a rather more in depth mental health history—what medications you’ve taken, what diagnoses you’ve gotten, what therapists you’ve gone to and when. They’ll ask you about dietary restrictions for no readily apparent reason, given that the cafeteria does not seem to hear about them; you also might get the option of talking with a chaplain, which as an atheist I did not take. My nurse, commendably, asked whether I wanted my parents to be able to contact me, which is a pretty decent level of sensitivity to abuse survivors. You’ll be assigned a room, which you’ll probably share with at least one other person.

Probably during your check-in, you’ll be told who your mental health help is. I was assigned a psychiatrist and a social worker, which I think is pretty ordinary. You’ll meet with them regularly; I met with mine every day. These meetings are not scheduled and will inevitably happen when you’re in the good part of the book you’re reading. You may have to give them another mental health history. Their primary concern is stabilizing you, which usually means some combination of medication, finding you a therapist for after the hospital, and waiting for you to get saner.

Most people in mental hospitals are either suicidal or undergoing a psychotic break. Some people are regulars who check themselves in when they feel very depressed. A few are there for other reasons—when I was there one woman was undergoing electroshock therapy and another was anorexic. They often have an acute ward for people who are very ill; I never wound up in that one, so I can only speak about the regular ward. They also have an adolescent ward, often: the adolescent ward tends to have more rules (including absolutely arbitrary ones like “no doughnuts”) and, I am told, is more miserable.

In general, on the regular ward, people are sad, gentle, and very kind. At least one person will sleep all day, either from depression or as a side effect of medication. Everyone will talk about what they want to do when they get out: see their children, play with their dogs, eat Mexican food, write a book. Most people will be quiet and too consumed in their own problems to pay much attention to you, but if you engage them in conversation many of the people are interesting. I met one person who was a geek, but due to depression hadn’t been able to keep up with anything geeky post-2000; it was fascinating to talk to someone who didn’t know New Who or Firefly.

Mostly, the mental hospital is boring. There’s a routine, which is comforting to a lot of people with mental illnesses: everything is utterly predictable, to the point that there is often a written schedule. They’ll wake you up fairly early. You’ll get meds, if you’re taking them, and have your blood pressure and other vitals taken. There are three meals, plus snacktimes, a day. Crafts are fairly common: I still have a vague suspicion that the sole purpose of art therapy is to entertain bored mental patients. You’ll have about an hour, usually in the evening, for visitors. Mine didn’t allow more than two visitors at once. You can also receive phone calls from people you’ve given permission to call you; although my hospital allegedly limited phone calls to ten minutes, it was roundly and gleefully ignored. Most of the day you’ll have nothing to do but play cards, talk to the other patients, sleep, read, or watch television.

My hospital had group therapy several times a day, which I think is more than most. One social worker moderated the group therapy sessions; he didn’t quite understand the concept of “atheist” and insisted I had to believe in some manner of Great Universe Spirit Thing in order to become undepressed, which was irritating. The social worker tried to make sure that everyone spoke once, but if you refused to speak they didn’t push it. People could and did skip group therapy sessions regularly and no one seemed to object much. They’ll often pick a topic of discussion, which may or may not be relevant to your life: for instance, I had incredibly supportive partners, so all the discussions about what to do when dating or married to an ableist asshole didn’t help. To me, despite my social phobia, it was oddly easy to be honest during the discussions, because the environment was very nonjudgmental and everyone was going through the same shit I was. I didn’t realize how lonely I was, feeling like I was the only crazy person in the world, until I met other people like me.

The book selection is shit, mostly composed of romance novels and book three of a fantasy series. The coffee is decaf. You will probably not be allowed to smoke, although they have nicotine patches. My hospital had a ton of Alcoholics Anonymous and Narcotics Anonymous pamphlets. At least at my hospital, you couldn’t go outside; there was an enclosed patio with some dying plants on it, and if I tilted my head enough I could see the sun.

The best tip I have, if you have a friend who is going to end up in the mental hospital, is to pack some things for them to take with them. Include a few changes of clothes, books, maybe a deck of cards, and something like a stuffed animal or a picture that will remind them of home; the hospital usually provides toiletries, but they’re awful, so you might want to include some of those too. Don’t include medicine, razors, anything with a drawstring, or anything a sufficiently creative person could use to kill themselves; the hospital won’t let them have it anyway. Ideally, get the bag to them before they check in, so they don’t have to wear crappy hospital clothes their first day. This advice also goes for the people who are going to the mental hospital themselves, but generally when one is going to the mental hospital one is not in a state to pack things.

Also, call and visit your friends as much as you can. Every day, if you can swing it. The mental hospital can be lonely and you get disconnected from the outside world, especially since lot of depressed people are already prone to believing that no one cares about them. Be supportive and don’t judge; if your friend’s in the mental hospital, they’re probably in a vulnerable state. It’s generally not a good idea to talk about how scared you are or complain about how you wanted to travel the world and this silly ‘depression’ thing is getting in the way.

My best advice for people who may end up in the mental hospital is that, if you’re planning a suicide or otherwise in desperate need of help and you can afford it, go. You might be unhappy in the mental hospital, because you are in emotional pain and that tends to make people unhappy. But the mental hospital can stabilize you and set you up with a treatment plan for once you leave; it’s a zero-stress environment where all you have to do is get better. I was terrified when I went in and by the end burst into tears at the idea of leaving.

Ozy Frantz is a student at a well-respected Hippie College in the United States. Zie bases most of zir life decisions on Good Omens by Terry Pratchett and Neil Gaiman; identifies more closely with Pinkie Pie than is probably necessary.

This was excellent, thank you! I haven’t been hospitalized for my depression but I agree that it can be a good thing if the facility is well-run. A good friend is a mental health worker and will routinely help consumers check into the hospital if they feel like their meds aren’t working well/they are slipping. They’re at the point where they realize it will be a few days, not indefinite, and that it will help them and they’ll be back home soon.

Thanks for posting. I am very glad you didn’t succeed, and yes, acetaminophen-induced liver failure is a terrible way to go.

One question: You didn’t say anything about physical exercise, although you said patients are not allowed outside. Is there any means for patients to get some exercise?

tots said: June 20, 20123:38 pm

In some of the hospitals I’ve been in, they had one exercise machine – like an exercise bike, or a very old stair-stepper – in the common area. It was more usual to be given privileges after a day which meant you could go on the group walks – typically half an hour, twice a day, in which you either walk outside through the hospital campus with a counselor or circle mindlessly on a tiny path near the designated smoking area depending on how large the hospital is.

Esti said: June 20, 20129:17 am

Thank you for sharing this. I don’t have experience with mental hospitals, but wanted to note that other hospitals also have restraints — I’ve had family members hospitalized with various medical issues (heart, throat, etc.) who were restrained at times because they were disoriented or lightly sedated and couldn’t be trusted to stay in bed/to not pull out all of the things they were hooked up to. So even restraints aren’t unique to mental hospitals.

M Dubz said: June 20, 20129:19 am

Ozy, I am so sorry to hear that you had to go through this, and I am tremendously glad to hear that you’re in a healthier place! Thank you so much for sharing this with all of us.

Bee said: June 20, 201210:32 am

I was in a mental hospital for about two weeks about two decades ago. To answer Comradde PhysioProffe’s question, at least at that time and in that particular institution, there was no way for patients to get exercise. And I think I agree with Ozy’s advice. It was not somewhere I wanted to be, and I didn’t like being there, but there was a very calming aspect to putting my life on hold and being in a place where my biggest decision for the day was whether to check off pancakes or omelet on the menu.

Ozy, I’m extremely glad that you made it through this experience alive and well and possibly with a few new tricks in your mental health bag. You’re an amazing person and an amazing writer. I appreciate you.

A few years ago, I typed out my journal from my mental hospital experience on my (now defunct) blog. In case anyone’s in the mood for more mental hospital reading material, I leave this link here. (I can’t think of a really elegant way to link to all of it, but it’s in about five or six parts — the link is to part #1, and there’s a “newer post” link on the bottom of each page that will take you to the subsequent parts.) (Also: possible trigger warning/s? I haven’t read it in a while.)

Oh, and I second Ozy’s tip for friends. My friends and mom brought me a copy of Wind in the Willows and My Antonia and a deck of cards. I liked having something (simple) to read and do, and even more than that, it meant so much that my friends (and mom) were thinking of me and didn’t hate me for being in the hospital. Things mean more when you’re locked up.

This is such an important post. There isn’t much info on first hand psych ward experiences, so for writing this I thank you. I am very sorry you have been struggling so much, whilst I don’t know you at all personally, I know your writing, and I am just so glad you were able to survive this and get help. If it’s not to personal, I’d like to know how you are doing now. Depression sucks, I am actually maybe going to be admitted, I am nervous about it – for all the reasons you listed. This despite the fact I formerly worked in a medical field, so logically I know psych facilities aren’t like that, but still, jerk brain prevails. I am going to speak to my doctor about this on Friday, not going to put it off any longer. Plus I am privileged enough to have insurance, so I need to take advantage of that before things get even more out of hand.

Annafel said: June 20, 201212:56 pm

Hey crying,

I don’t know you at all, but I really hope that you get the help you need and start to feel better. You are incredibly strong and brave to have figured out what you need and how to get it. I want you to know that even strangers like me care about you and want you to live and feel okay. Best of luck,

Annafel

TheJackdaw said: June 20, 201212:30 pm

This is very similar to the UK! I’ve had a few stays in a few psychiatric wards and they were all generally the same. They are very quiet (unless someone has a crisis) and generally pretty dull. There were no group therapy sessions when I went (the last stay was 7 years ago) and your sessions with a psychiatrist depended on how ill you were. There were inside smoking rooms until the ban came in and that was a good space to chat or meet people.

The last episode I had, I was offered a stay in a hospital but was warned there would be a lot of addicts in the wing and it wasn’t particularly calming. Instead they had a programme where you could stay at home but you could be visited by one of a team of psychiatric nurses and they would visit you as many times a day as you wanted and stay for as long as you needed. They would make sure you were taking your meds, were eating and obviously that you were still alive. It was really good and a great way to get the help I needed without losing too much autonomy.

Annafel said: June 20, 20121:18 pm

Ozy, thanks so much for this post. I do not know anyone personally who has been in a mental hospital – that I know of – so I am really grateful for this perspective. Also I read One Flew Over the Cuckoo’s Nest last year and found the so-called medical practices therein very disturbing, so it’s good to hear a counter-example of actual current reality.

This post will definitely help me be a better friend to the people I know who are dealing with mental health issues, and if my own issues get to the point in future where I need this kind of help, I think it is something I would now consider much more readily, and with less fear and judgment, than I would have otherwise. Thank you.

Never Going Back said: June 20, 20123:00 pm

I was in a mental hospital about a decade ago also after taking a massive amount of Tylenol. (High five for my “poor choice in method of suicide” twin!) Sadly, my experience in the hospital was not as positive as Ozy’s. While it wasn’t exactly One Flew Over the Cuckoo’s Nest, it was infantilizing to the point of dehumanizing. I was treated like a dangerous madwoman by every member of staff. As such, every single thing I said was assumed to be either a manipulative lie or a product of a delusional brain. There were arbitrary food and sleep restrictions. All day, every day, we were to sit in the common room with the TV on full volume. Reading a book was a sign of illness. Sitting in a chair in your room was a sign of illness. Wanting to go outside even though you don’t smoke was a sign of illness. Wanting a cup of tea was a sign of illness.

I knew these things were not helpful for my recovery, but I was ignored or silenced. What did I know about my own body or needs? I was a dangerous madwoman. Do what the nice doctor says. If you don’t, you are “non compliant” and another day will be added to your stay. Follow their expectations, put on some lipstick, be a good girl, and you can leave on time. (Yes, they insisted that because I wasn’t applying daily makeup I was too ill to leave the hospital.)

But — if you ever think you might need hospitalization (and you have the means), please please please go check yourself in for observation. If you check yourself in voluntarily, it is much easier to get out and try somewhere else if it turns out to be a bad place for you.

Atalanta Pendragonne said: June 20, 20124:00 pm

My experience in a mental hospital was better than Never Going Back’s, but not as positive as Ozy’s. This was in 2000, so patients who weren’t on suicide watch were allowed to go out for cigarette breaks. Visitors could pretty much come and go during the day. There wasn’t much in the way of therapy. I got kicked out of group for scratching an itchy scab (scratching, not picking). I didn’t get much info on what meds I was being given. They did a blood draw every day and scolded me for metabolizing Depakote too fast – once I woke up to a tech tying up my arm for a blood draw!

Also, they tossed me out when my insurance ran out, saying I “wasn’t being an active partner in my treatment”, and the social worker just handed me a phone book and told me to pick a therapist and p-doc… no referral or anything!

Keely said: June 20, 20124:22 pm

I’m quite atypical in that I’ve never been hospitalized myself for mental health conditions, but I’ve known many people who have, and heard or read lots of first-hand accounts of the experience. This is because, in addition to depression and anxiety, I have or have had in the past many of the traits associated with borderline personality disorder.

I say that I have ‘traits’ of borderline rather than saying I am borderline, because my doctors have always struggled with giving me that diagnosis, for much the same reason that I’ve never seen the inside of a psych ward–I’m (at least outwardly) a lot more stable or ‘normal’ seeming than the typical borderline patient. I have self-harmed (rarely and never in ways that seriously threatened my health), but never attempted suicide. I do have incredibly volatile moods, with seemingly minor incidents sometimes swinging me up or down to a ridiculous degree, but I don’t really ACT on those moods except to have crying spells alone in my room or rant to close friends about a situation that is frustrating me. I am hyper sensitive to signs of rejection/disapproval, but this doesn’t lead to me blowing up my relationships. Basically, I experience much of the inner turmoil typical of borderline personality disorder, without displaying the more troubling behaviors or extreme instability psychologists generally expect from a BPD patient.

I don’t say this to brag that I am a “good” or “more healthy” mental patient than others, but rather to explain the rather surreal position I find myself in while receiving treatment. I have been in many therapy groups in which I am the only person that has never been hospitalized. I’ve sat across the room from someone just off the ward after a suicide attempt and listened to them recount thought patterns that I myself have had hundreds of times. Often I feel like an idiot discussing my ‘problems’ in a group therapy setting, because while I’m struggling to believe that my new amazing girlfriend really loves me, or to be more calm at work despite a super anxious boss whose moods I tend to catch like a disease, the other people in the room are trying to deal with severe self-harm, or trying to get healthy enough to hold a job.

My feelings towards the other members of the groups I have been in are complicated. I wonder how, if we all have the same illness, why I am able to at least present a front of a normal, successful-ish (I’m 2 years into a PhD program in biology) life, and they struggle to stay even sort-of stable.

I’ll admit that at times I have wanted to distance myself from these people, been slightly disgusted that anyone would allow themselves to reach such a state of collapse. And frankly, many of my friends who perceive me as “a bit sensitive/emotional, but stable and relatively normal” have encouraged this view, as they are uncomfortable with the idea that I may have something in common with people in much more obvious states of distress. But more often, I empathize with the other people in group. I understand exactly how they arrived where they are, know exactly the paths their minds have lead them down. I recognize the resources and luck that I have had and they have lacked.

I also recognize that my family history uniquely prepared me to be a secret mental patient–denial has always been the name of the game in my home. You don’t talk about problems, you deal with them as quietly as possible or ignore them altogether. Extreme/negative emotions, in particular, are unnecessary and largely shameful things that are not to be indulged by acknowledging their existence. My family was always perceived to be a picture of white-picket-fence perfection, and above all our unspoken goal was to maintain that image. We were incredibly successful at this, to the point that during my early childhood I fully bought our bullshit and believed any problems I saw to be uniquely mine. My family was perfect, it was me that was over-sensitive and generally defective. But if I hid that well, I could still be a part of my perfect family, and I could make them happy, which was all I wanted.

So I suppose it isn’t surprising that coexisting with the incredible volatility of mood and self-destructive tendencies of BPD, I have an equally strong drive towards keeping-myself-functional [enough to get by]-above-all-else. And in some ways, I am grateful for this somewhat twisted gift. Because I have seen people–friends, if only in group–cycle in and out of the hospital, severely disrupting or sometimes destroying school or work careers. I’ve seen people utterly demoralized by the time they’ve spent “in the system.” And I don’t want that for myself. I have a job and a life and I don’t want to lose them, or even interrupt them. I also value the “generally-stable” image I have managed to keep up with the people with whom it would be most dangerous to lose it–namely, untrustworthy family as well as everyone in my professional life–and I’d really prefer not to lose it.

But the strangest feeling I’ve had about my group-mates? I’ve been jealous. I know hospital stays are not glamorous or particularly pleasant. I don’t want to worry people who care about me by declaring myself unstable enough to need a hospital visit. But sometimes–particularly times like now, when I’ve been hit with an episode of depression followed by setbacks at work and I’m just TIRED of trying to appear okay while all of this swirls under the surface–I yearn for the ability to give up. To collapse. To spend a few days with no decisions to make except maybe which of two crummy hospital meals to choose. To take away most stimuli for a few days so my fried emotional system can re-equilibrate. And while most of me is terrified of being perceived as crazy or sick, a tiny part just wants my struggle to be acknowledged, to be made real.

Because I am capable of going on, of maintaining the facade, however shaky it may become–I feel I have an obligation to do so. But it gets so fucking tiring.

I am aware I’m not unique, as I quietly go to solo therapy and group therapy each once a week, and then slip back into my ‘normal person’ life where most people are unaware of my issues. Lots of people with mental illness are never hospitalized, sometimes even during fairly severe episodes. Lots of people quietly take their handful of psych meds every morning and then go about their day like anyone else. Lots of people have this quiet struggle.

Probably the most unique thing about my situation is that I [have? sort of have? have a mild case of?] a condition that is absolutely expected to produce breakdowns and suicide attempts, and my treatment history has happened to give me many chances to look across the line to the other side, from the “fucked up but functional” to the “truly disabled by their condition to the point of being unable to manage an appearance of normality.” There are the people who quietly struggle with depression, go to the family doc and get some pills, and move on, without ever having to face being really crazy. And then there are the people who have war stories and personal opinions about multiple psych wards in the area. And a lot of the time, the ones with the luxury of appearing normal get to think of themselves as truly separate from the others.

But me? I see the line. All the time. I know how thin that line is. I know my distress has often been just as real and severe as that of any of my groupmates. And I know that, despite whatever distinctions the ugly judgmental bits of my brain would like to draw, I really am one of them.

E said: June 20, 20127:30 pm

Your story is really interesting, because it sounds familiar to me…the hypersensitivity and mood swings, in combination with the denial and the “perfect” family. I have wondered if I’m borderline, but I haven’t done much therapy, so I haven’t been diagnosed (and also, I hear it’s not very typical of people with BPD to think that they have it, so maybe I actually don’t). I relate to what you said about knowing you can keep it together, so you will, but seeing other people fall apart and totally understanding how they feel. I also “like” the idea of having a place to go where you have no obligations and no decisions to make. Anyway, thanks for sharing.

Keely said: June 20, 20124:45 pm

Oh, and I left this out… Tylenol as a method of suicide fucking terrifies me. I deliberately avoid having large amounts in the house, despite a very low likelihood of me ever making an attempt, because the stories I have heard about both successful and failed attempts are so horrifying. It can be a long slow death, often allowing plenty of time for you to get past the suicidal impulse and be ready to give this life thing another go… but whoops, you already destroyed your liver, and you can’t stop it now. There is also the chance of it causing serious damage, but not QUITE killing you, and severely and irrevocably damaging my body in a failed suicide attempt is a big nightmare of mine.

Basically, Tylenol is a dangerous drug, and it frankly blows my mind that something so easily lethal is sold over the counter and taken like candy. It’s not just dangerous for suicide attempts, accidental overdoses, particularly of kids or people who combine it with large quantities of alcohol, are shockingly common. It can obviously be used responsibly but I don’t get why we need to bother with the added risk of liver damage (even if it is small-ish) when other NSAIDs can serve the same purpose most of the time with less scary side-effect profiles.

tl;dr

1. Try ibuprofen/asprin/naproxen/etc for fevers and minor pain/inflammation, especially if you drink a lot or have young kids or have suicidal thoughts or are just a scaredy cat. And for god’s sake, don’t take tylenol before drinking to “prevent a hangover”.

2. You shouldn’t attempt suicide for lots of reasons, but if you do, don’t go with Tylenol. Not a pleasant way to go.

I’ll try and keep this short since it’s not awfully on-topic, but part of reason, seemingly, that acetaminophen/paracetamol (what kind of drug has a whole separate generic name in some countries anyway?) is over the counter is that “ibuprofen/asprin/naproxen/etc” are a bad idea for a substantial proportion of the population. People with hypertension (11% of the population in Australia) aren’t supposed to use any NSAID except aspirin other than under medical supervision. Children can’t be given ibuprofen until 6 months of age and aspirin until puberty. (Paracetamol is possible from 1 month, and we were glad of it when our son started screaming in agony after his tetanus vaccination and wouldn’t stop for hours.)

And in pregnancy neither ibuprofen nor aspirin are safe for the fetus, and many pregnant people find it is almost impossible to get anyone to prescribe anything for a “irritation” like, say, a constant agonising headache because Good Mothers are drug-free. I was very glad paracetamol (and later, when my blood pressure rose, codeine on the advice of my doctors) was available over the counter during my pregnancy.

That said, it might still be worth it to take it off the OTC market (I too know how dangerous it is, having had family members with dementia who were at risk of forgetting how many pain killers they’d taken), but ideally only combined with a more permissive attitude to use of painkillers on the part of the health professionals who sign off on use of painkillers, because there’s a fair number of people who can’t use NSAIDs for pain.

Yes, this, all of this. I’m currently taking Lithium to manage my mental illnesses, and the only pain medication that doesn’t massively contradict it is Tylenol. Even Ibuprophen sends me into toxicity, and I’m just flat out allergic to the codone family of pain meds.

Keely said: June 20, 20126:34 pm

I’m so sorry, I didn’t realize the extent of contraindications for other NSAIDs. And I don’t mean to imply that Tylenol is evil under all circumstances and must be avoided. In general, I think most drugs should be easier to get, and in particular I have a problem with the fact that access to stronger pain killers is often blocked by a physician’s personal prejudices. I would never want a doctor’s biases to get in the way of you getting proper pain medication for your crying child.

What I find unfortunate is that, given the way the system is currently set up, many people tend to believe that OTC = very safe and prescription = serious/dangerous stuff. Given that context, I find it scary that Tylenol is OTC.

But you’re right… having no OTC alternative for people who can’t take other NSAIDs would be a shitty trade-off for reducing Tylenol overdoses by not having it available over the counter. Getting a doctor to prescribe painkillers is rarely trivial, and everyone should have the right to basic relief of pain/inflammation without justifying it to a doctor.

thoughts galore said: June 23, 201210:37 pm

Also,NSAIDs aren’t as safe as Tylenol for endurance athletes (marathon runners, ect..). And I agree with above abut prescribing – especially since, “I’m running a marathon and might or might not cramp up at mile 15” would be a sucky reason to have to get a prescription.

I think a lot of the problem with the ubiquity of Tylenol comes from the way it’s bundled. It’s in EVERYTHING, from opiates to OtC cold medication, which makes *accidental* overdose incredibly easy if you don’t know to watch out for it–which a scary number of people don’t.

Veronica said: June 21, 201211:30 am

Tylenol is primarily available partly because of the reasons in Mary’s post and partly because there are a lot of patients out there suffering from chronic pain and taking Tylenol off the OTC list would leave them one less option if they want to avoid controlled substances. Opiates are expensive, high-maintenance, and come with a whole load of side effects that make doctors hesitant to put people on them long term unless absolutely necessary. If it makes you feel a bit better, though, the FDA has recently considered lowering the maximum dosage (currently 4GM/24hrs) to 3GM/24hrs out of concern for the overlap that can occur with patients who are on combination opiates (Vicodin, Tylenol #3, etc.). Additionally, hospitals now have access to some very powerful antidotes (Acetadote IV and acetylcysteine inhalation/oral), which is actually more of a reason to avoid Tylenol – that 2-3 days dosing regimen makes for a pretty damn miserable hospital day.

Bev said: June 21, 201211:57 am

Possibly a large warning saying “PARACETAMOL/ACETAMINOPHEN DEATH IS SLOW AND PAINFUL” would help, sort of like a reverse cigarette packet. Certainly, one saying “DO NOT COMBINE WITH ALCOHOL” instead of it being buried in the enclosed leaflet would do worlds of good. Also, I have no idea how House still has a liver if Vicodin contains paracetamol.

The other reason Tylenol and its generics are available is a biggie: they got grandfathered in. It’s extremely unlikely that a new drug with the profile of acetaminophen would make it past the FDA in the US. (I know nothing about the requirements in other countries.)

Yup, this is about right for persons with supportive partners and good insurance, both of which I had. The hospital is pretty boring, but can be calming due to the enforced structure. The paragraph about the patients and their behaviors (“at least one will sleep all day”) is spot on.

My experience differed from Ozy’s, however, because I was undergoing a post partum psychotic break when I was admitted. (This later led to a diagnosis of Bipolar I.) The hospital workers were kind in retrospect, but in my state of mind, I pictured them as threats. On the plus side, despite mostly being disgusted with my bodily fluids, they were pretty accomodating with my desire to breastfeed my one-week old infant (I handled all of the pumping and refrigeration myself). Unfortunately, despite my constant whining about having to change upwards of 150 pads in a week, they also missed or ignored my massive post-natal hemorrhage. By the time I ended my “visit” there, I was so anemic I could barely stand up straight.

I’ll share from the opposite perspective–I work in an ER with a dedicated psychiatric unit and often work on that unit. And honestly my feelings about it are… mixed.

Mostly, it’s boring. The psych ER is a tremendously understimulating environment–you get a bed, a chair, and if you’re lucky a tiny TV with three channels. You don’t get to interact with other patients much and you don’t have any planned activities. It’s relaxing for people who just want to sleep or need quiet time to decompress, frustrating for people who need stimulation. Staying in the ER is meant to be a stopgap before someone gets a real hospital placement, but the system is overloaded and people are often stuck for days and sometimes over a week before a bed is found.

It’s also very restrictive. Security takes away and locks up people’s belongings–most security officers will give you back your phone and books and other “no sharp edges, no long strings” items if you ask nicely, but ultimately it’s up to their whims. Patients are expected to stay in their rooms except when they’re going to the bathroom or shower, which is pretty harsh when someone might be staying four or five days with us.

We have “sitters” who have to stay with and watch our psych patients 24/7. This is kind of good because they can do things like get you food and communicate your concerns to the nurses and talk to you when you’re bored to death. But it also means that there’s someone watching you 24 hours a day and you’re not allowed to be out of their sight. Depending on the sitter and your situation, they might even follow you to the bathroom.

I don’t want all this to discourage people from coming to the psych ER if they need it. What we do have, besides tiny televisions, is 24-hour clinicians who talk to every patient within hours of their admission and at least daily thereafter. They’re only okay counselors, but they’re amazing social workers–their real strength is connecting people to the resources they need–they’ll sort out if you need to be admitted or go to detox or get home visits or outpatient therapy, and they’ll do what it takes to get you what you need. Their services are the real meat and potatoes of what we offer psych patients in the ER, and they can be literally lifesaving.

Medication treatment in the ER is mostly anti-anxiety drugs for people who are very agitated–we usually don’t start antipsychotic or antidepressant treatment. On the plus side, unless someone’s actively violent, we don’t force meds. We also don’t restrain unless someone is being violent. (Or… unfortunately, if you’re deemed an involuntary patient and you try to leave, you will get brought back by Security or the police, and may be put in restraints if you physically resist. I hate the way we handle this, and I know it scares people away from getting help from us. But it does happen so I’ll share it.)

In general, the experience for our patients in the psych ER is boring, frustrating, at times downright infuriating–and it’s also often the doorway to them getting real help for the first time. I don’t think anyone likes it, but a lot of our patients do end up glad they came.

Oh, and a tip: If you come in for drug detox, make sure there’s some of the drug still in your system. I know this sounds counterproductive when you’re trying to quit, but a lot of places won’t start withdrawal treatment unless they find some of the drug in your urine screen.

(For the same reason, don’t refuse or try to game the pee test.)

Mouse said: June 21, 201212:43 pm

I’ve never been fully hospitalized, but have been to the psych ER three times; twice I took myself, and the third time was brought there by police because my neighbors called them on me as I was, apparently, screaming. (I admitted to a suicide attempt and they committed me — I guess they can do that! Go figure. Oh, right, suicide is illegal.) I WISH we had chairs or TVs in those rooms. There’s nothing. Just a bed. Otherwise, it’s entirely empty. I was barely spoken to, either; I felt fine and had calmed down by the time the police showed up.

I’ve been in psychiatric wards twice. One was amazing and wonderful, attached to a hospital. Constant therapy and help and it changed my life. The other was basically county based and I feared for my life. Violence broke out immediately and in a week and a half I was only seen by a therapist twice and that was because I begged. One told me to “just love yourself” and the other told me to pray. Welcome to the difference between private insurance and Medicare, I’m thinking. But both kept me alive and, ultimately, that’s what matters.

solecism said: June 21, 20127:37 am

I don’t have direct personal experience, but I have various loved ones who cope with a range of mental illnesses, have listened to some of their stories. Yes, I understand that the difference between the county-run facilities and private ones can be tremendous, and the treatment of patients on Medicare vs private insurance likewise. Also, voluntary vs involuntary commitment. Along with the involuntary can come being medicated without consent. As a result, there can be a deep distrust of medical personnel and a profound unwillingness to seek help or try new prescriptions, because sometimes the results of professional intervention seem to be so much worse than being left alone. I am glad that Ozy got the help and space that was needed and had a positive experience.

Bev said: June 21, 201211:42 am

I had a similar experience in regular therapy, one therapist believed in “energies” and did the stupid tapping thing where you say you love yourself (ECT?), and the other told me my fear of death was irrational and told me to try faith. Hopefully the difference between uni mental health resources and the actual NHS are the same as Medicare and private…

Holy shit I had a therapist that did the SAME THING. And then I quit going to therapy and a month later, in something that was no doubt a complete coincidence and entirely unrelated to someone attempting to treat depression with tapping, I attempted suicide.

Bev said: June 24, 20127:04 pm

It’s the funky new technique so they’re trying it on everyone, I think. Luckily, fear of death means no attempts for me, and I also cured myself of most of the symptoms by turning in the bastard who created my not-PTSD.

I think the tapping thing you mean is EMDR — in the hands of a skilled practitioner, it can be really useful. I’ve gotten some good results from it, but I’ve never had a therapist use it while telling me to say that I love myself. It’s intended to be used as part of a treatment plan for PTSD, but the methodology is pretty complex.

Bev said: June 24, 20127:01 pm

Okay, it’s actually not a stupid technique if you’re the right kind of person to accept it and actually have PTSD. Neither of those are true of me. I apologise for not thinking about my words properly.

I think you’re talking about EFT — “emotional freedom technique.” EMDR is the thing where someone waves their fingers in your face.

I’ve heard positive things about both from people who have tried them If they work, great. If they don’t, and the client is suicidally depressed … maybe the therapist should try a different technique sooner than later. Echhh.

KJ said: June 20, 20127:37 pm

While generally, I loved this article, as I have both been in and worked in psych units, can I offer a defense of art therapy? It shouldn’t be craft time, if it is run by a registered art therapist who is on his/her game. Unfortunately, art therapy rarely is run by such a person, as for some reason, people in the mental health profession refuse to admit that art therapy is more than pretty pictures and crafts and thus assign an unqualified person to run it meaning it is CRAFT TIME!!! Which is not the point of art therapy. Art can be a great way to help people get in touch with deeper emotions and explore their life and problems in a new and creative way. Please don’t judge all art therapy by the CRAFT TIME! mentality of hospitals/groups that refuse to pay for a registered art therapist who might have ideas that go beyond CRAFT TIME!

Also, I love crafts- don’t take this as an indictment of crafts. But CRAFT TIME! where the point is to make a pretty do-dad, is not art therapy.

swevene said: June 21, 20128:53 pm

I did an intensive day-treatment therapy program and I loved the art therapy group. We would draw pictures on a theme and then everyone would talk about what they saw and it was really valuable.

I second this. I know an art therapist who gets really cranky over the difference between “art therapy” (requiring a massively trained therapist, but really powerful) and “art IN therapy” (get your popsicle sticks!).

JF said: June 22, 20128:22 pm

There is a difference between art therapy and crafts, but both are beneficial. Crafts are considered occupational therapy. Actually, when I was in the hospital, I liked occupational therapy better than art therapy–I found I could focus on something outside myself and soothe myself better. I didn’t want or need to talk about troubling stuff at the time. I needed to focus on something else and let myself heal. When someone is in a mental health crisis, they often really don’t need to concentrate on the “deep” internal stuff–for a lot of people, distraction, focusing on the outside world, and doing physical activities is really necessary, and crafts can really help with this.

KJ said: June 20, 20127:52 pm

Also, allow me to explain restraints, from the perspective of a staff member at a psych hospital. In today’s hospitals, restraints should be rare, as most states mandate that they only be used as a last result to keep people from harm. Before you can restrain, you have to go through a very long training. Generally, we can go hands-on only if the client is assaulting someone. So if a client punches someone once, then walks away, we can’t restrain that client, as he or she is not currently assaulting. If the client keeps hitting, we can restrain. Also, know that staff hates restraints. They are dangerous for us (we’re more likely to get hurt in a restraint than the client is), they are scary, they require real skill and the paperwork is complex after a restraint. We don’t want to do them, but will to keep the ward safe and secure. We also can restrain someone if they are at immediate risk of committing suicide, but that is rarer.

Most people who staff the psych hospitals are pretty nice. But it is a hard job and workers don’t last long because the work is soul-crushing at time. We see human misery at its worst. We try to help. But we know that we can only do so much. Some people get jaded and I’m sorry if anyone has to deal with that type of worker.

The difference between adolescent and adult psych wards is absolutely enormous. I’ve never been in an adult ward, but comparing the stories from people I know to my own experiences on an adolescent ward is just….rage inducing. The only thing I got out of it was being started on medication (And even that was iffy, as I reacted badly to the class of medication and they continued to prescribe different medications in the same class even after one of them made the problems it was meant to treat WORSE.)

For starters, I was never told my diagnosis. I didn’t find out what exactly it was until years later. I saw the psychiatrist working the ward that week all of once, and his bedside manner was…less than stellar is being polite.

I had pretty much no autonomy or say in my treatment and they treated everyone on the ward like five year olds. We weren’t allowed any physical contact at all, we had to check in with a staff member every hour regarding any “bad thoughts” and could be denied basic privledges just for having them on the whims of the staff member in question (One girl got her freaking BEDFRAME taken away for this). And absolutely no visits from friends. The only people they’d let up there were direct family, so if your family was part of the problem…tough luck.

alphakitty said: June 21, 201212:23 pm

OK, so got a question for you: I have a friend whose 16-year old son has mental health issues, with a soupcon of addiction from attempts to self medicate. (The mental health issues seem to be the driving force in his self-destructive behavior, and the cause of the addiction, rather than the addiction being the source of the mental health issues). Outpatient therapy hasn’t been doing it; law enforcement is involved; counselors are now recommending some inpatient treatment.

What, if anything, can my friend do to check places out, and to make sure his experience is helpful rather than damaging?

Elysian Deliration said: June 21, 201212:40 pm

Honestly, I don’t have any good advice other than do your research and don’t go to a psych ward attached to a county hospital. I do hope your friend’s son gets the help he needs, though. It can definitely make a difference.

KJ said: June 21, 201212:48 pm

I work in an adolescent inpatient unit. I’d look at what positive behavioral supports are in place, such as motivations to do well (level systems, token economies, etc.) They should be able to show you a level system and what it takes to move up levels. Level systems provide motivation and support to kids who need incentives.

I’d also insist on talking to the staff before admissions. Don’t talk only to the therapist though, talk to the line staff who have the most interaction with the clients. Make sure the line staff are smart and educated, because they end up doing most of the crisis interventions. Also, make sure the kid will see his or her therapist at least 3x week if at all possible- less than that and why be inpatient? A psychiatrist should be on-call 24/7 too.

Tours are good too- the facilities don’t need to be fancy, but they should be safe and secure. There should be opportunities for kids to earn trips into the community, so the kids feel more normal.

Also, make sure that the schooling of the kids is happening. Schools in inpatient facilities are often jokes and the kids get discouraged when they realize how far behind peers they are getting. Talk to the teachers, if possible.

Also, make sure the kids has the chance to call home at least once a day. A red flag is when facilities limit the ability of kids to talk to their parents.

I am coming from a position similar to Cliff Pervocracy here. My father is a full-time psychiatric nurse at our local hospital, which has an independent floor for psychiatric patients. Back in the day, before 2003 or so, I was allowed to visit him at work and hang out in the ward until he could come get me. This was probably against policy, but most of the patients liked talking to a youngish kid (10-12), so the doctors allowed it.The impression I got from this was that they were really, really bored. Over the years I’ve watched my father fight a lot of the policies that made this situation worse. Initially they only were allowed to read when monitored and had no un-monitored activities. Since then he’s convinced the hospital to allow a small library (and for the patients to request books from the hospital library), jigsaw puzzles, and board games. I’ve also known him to bring in treats for some of the more long term patients.

Moral of the story is be nice to the nurses and you can get benefits.

Scarf said: June 21, 20124:05 pm

Wow. I worked on an acute inpatient ward in the UK. Some similarities, but some glaring differences.

My ward was a 20 bed ward: 14 men and 6 women (with a locked door between the male and female sections). The female area had two 2-bed rooms and four single rooms. The male section had one 4-bed room, three 2-bed rooms and four single rooms. Meds were at 8am and we locked the bedroom area at 9:30 ish, so people had to be in the communal areas during the morning. After lunch it was more relaxed, although it was still preferred for people to be in the communal areas. There was a tiny female-only living room in the female area, which we’d allow the female patients to use during the day if they wanted.

Breakfast was toast or cereal. Lunch and dinner were served school-cafeteria style from a choice of two or three hot meals. No option to choose beforehand. However, the cultural and dietary requirements were pretty good – halal, Caribbean, vegetarian and diabetic-friendly options were all available, and would be sent up in little trays separate from the main food. Vegan was unavailable – one client asked for that and received tuna and cheese on a baked potato. Hrm.

We had two TV rooms, a pool table (to be used under supervision only, so the equipment was locked away but available on request as long as a staff member was free) and an open seating area with just chairs and coffee tables. There was a courtyard, but I can’t remember whether it was always open or only on request.

Most people were allowed out – either by themselves, with varying timeframes (ranging from 15 minutes to 4 hours – and voluntary patients could of course come and go as they pleased), or with a staff escort. We tried our best to facilitate trips out as often as possible, but sometimes we were too short-staffed.

The most concerning difference was the lack of therapy. The Occupational Therapists ran some activities, but they didn’t really have the time, space, staffing or equipment to make these truly therapeutic, so they were mostly just activities to make the day pass more quickly. There was no individual therapy. There was no group therapy. People saw their psychiatrist once a week (or once a fortnight… I can’t remember, but I’m leaning towards the latter). This was only for ward round – where the doctor met the client, with a trainee psychiatrist, I think maybe a nurse? and possibly the client’s family – and the aim was to discuss how they felt their care was going, check medication, plan for allowance of leave, etc. No therapy there.

One other major difference (although I’m possibly just reading it wrong…) is that it seems that in the US you use restraints, I.e. like tying a client down? In the UK, we restrain, meaning we hold the client down ourselves. Pros and cons… Tying means the client can be given space to calm down – difficult to do when you have 5 adrenaline-charged people holding you down. The benefits of holding is that you have four people holding (in ways very uncomfortable for the holders but really quite comfy for the holdee – I experienced being held in my training) and one person whose job is just to talk to the client and make sure they’re OK, not too hot, too thirsty, are they calming down, is it safe to release them yet, etc. In restraint training we heard horror stories about tying people down and leaving them, and coming back to find them dead.

Celli said: June 21, 201210:04 pm

I was hospitalized in three facilities in two different states in 1997, 2009, and 2011. The last one was the best of the situations for me. It was a combination of a lot of factors working in my favor (my psychiatrist was filling in on the ward that week, which NEVER happens, and which meant that I didn’t have to explain the whole thing over and over and over again) and some semi-planning ahead, among other things.

I also had a couple of scripts ready before I went in (and had practiced them with my therapist). I’d had a problem the time before with getting clothing I felt safe in. They didn’t have scrubs my size and nobody told me I could have my street clothes back, so I was stuck in a very short gown. I’m a sexual assault survivor. A lot of the process of being hospitalized was scary for me anyway, and feeling vulnerable like that made it a lot worse. So this time I had a practiced line: “I understand that you need to put me in a gown, but I’m a sexual assault survivor and I’m not comfortable with just the gown. Can I get a pair of scrub pants, please?” I said it over and over to everyone who came in range, and they actually just let me keep my dress pants when they couldn’t find scrubs. They were a little grubby by the time I got released, but I didn’t care.

Another thing that helped me was having people wait with me while I sat in the ER and waited for a bed to open up (this may not be allowable everywhere, I don’t know). They kept me distracted and I didn’t get much of a chance to start worrying about things outside my control.

The rest of my experiences seem to be a mixed bag of what people have already talked about.

I’m glad it was a helpful experience for you, Ozy.

Beth said: June 22, 201212:45 pm

Thank you so much for this post. It was really helpful. In the past when I’ve been suicidal I have avoided the ER like the plague because I was afraid of what it would be like. Now I’m less scared. I do have a couple questions. If anyone can help I’d be really grateful.
1. I have a HUGE fear of needles. Do I have the right to refuse getting blood drawn?
2. What would I do about my job? Would I be able to call in and tell them I’m in the hospital? Would they have to know that I’m there for mental health reasons and not physical illness?
Thanks!

TR said: June 23, 201211:16 pm

Assuming you’re in the USA:

1) I’m not sure, but if you self-admit and it’s not deemed necessary care and you’re legally mentally competent (able to make/understand your decisions), than probably. I know for physical ailments (assuming one is in good mental health) you can refuse any/all treatment. I imagine the line is harder to draw with mental ailments.
2) Treat it like any other health disorder; if it’s an emergency, it can be covered by your sick days or FMLA if necessary, if it’s not you should probably plan to use your vacation or sick days if possible, and let your boss know that you are seeking necessary medical treatment if it’s sick days, but treat it like you would any other illness – you don’t have to give details. Poke around askamanager.org – she’s got some good advice on this (like hey! It may be covered under the ADA and there are laws protecting those who suffer from mental illnesses).

Also, another note: Psych/health facilities also depend on your location. If you’re in a rural area, where the nearest facility doesn’t have a full-time surgical ward (fun fact! A burst ovarian cyst misdiagnosed as appendicitis can eventually make you pass out from pain!), much less a psych ward. You may just get send to the nearest hospital with an open spot if you’re involuntarily committed and have to stay there for lack of better options.

This happened to my mom; she got send to one of two wards within a 200 mi radius, and even though we have insurance and can afford private treatment, she ended up in a state hospital that had a lot of really ill people and not enough money. Her friend, in a similar predicament/financial situation in a major city with one of the world’s best med centers, ended up in a private hospital with much better care and facilities.

Reading through the comments it seems a bit like finding the right place, if you can’t afford just paying for a big-ass private place, is a bit of a crapshoot. I have problems with seeking medical help for my suicidal impulses and self harm anyway, and this makes me more hesitant. Also, for me, there is a catch-22 type issue involved: as long as I am alive (and more or less functional, as far as work and phd work is concerned), I’m not sure I’m experiencing a lack of control that would necessitate getting admitted. It’s a strange and difficult issue, overall. Thinking of suicide every day, all the time, is balanced by holding down a job, writing papers, going to conferences and applying for grants. If I can do these things and clearly am not dead, am I at risk? The basic fear is being perceived as whiny and complainy, which is why I’m constantly looking at info on this. So thank you for your post and all the comments below.

Courtney said: June 30, 201212:15 pm

I don’t know if you are at risk, but you are clearly suffering. It is possible that treatment may alleviate that suffering. In my book, that’s a good enough reason to try things. If nothing else, finding better ways to manage the feelings you have may make it easier to do all the awesome things you are doing.

You are not whiny or complainy to want or need help with constant suicidal ideation any more than I am needy for wanting help with frequent migraines.

I also think that whining and complaining are okay things sometimes, because sometimes that’s just where we are. But wanting relief from suffering is totally legit.

Kathryn said: July 1, 20129:10 am

You sound like me. I finally sought help because I was hallucinating and it was interfering with my ability to get to class on time. I was (am) not tolerant of things that get in the way of me functioning.

You may not need inpatient care. I have, frankly, avoided it because I don’t deal well with loss of control and it scares me.

But add to your “needed to function” list some of the steps toward seeking help. Find a therapist. If they suck, find a new one. Repeat until you find someone you work well with. Not having to shrug off and handle suicidal thoughts all of the time is astonishingly freeing and you deserve to know what your life is like without that drain. Doing the work is hard, and often far more frustrating than just functioning (which you *know* you can do) but the pay offs are worth it.

Dicentra rubra said: June 26, 20124:21 pm

Sorry this is a few days late. Comradde PhysioProffe, I was hospitalized for depression a few times in the mid-late 90s and at that time, *if you had off-ward privileges* (which varied depending on mental state and compliance etc), then yes, we went down to the hospital’s exercise room every day from 4-4:45.

Ozy, kudos and admiration for your bravery to make it out the other side of the attempt. And thanks very much for your account. It jibes very well with my own experiences even though they took place almost two decades ago now. For me (also at the time privileged with excellent insurance), the hospital was just what I needed. There was a really intense, chastened shock when I woke up in the ICU after my attempt, and the shock continued to infuse the atmosphere of the mental ward as well. I had been broken down by the depression into absolute vulnerability, real life was of necessity on “pause,” and the people there gave me the space to grow back again. I will always be grateful for that.

The hospital I stayed in had one restaurant, a McDonalds, and after I got off-ward privileges my sweetie would walk down there with me every night and we would have half an hour to eat and hold hands and talk. For *years* after, even though I actually hate the food, McDonalds was my ultimate comfort place, just because it had been where we could be together when I had very little left.